The Trump administration has done it again, sending shockwaves through global health communities, by mandating a 90-day halt of U.S. foreign assistance, significantly affecting vital health initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR). This choice, implemented via an executive order on his initial day in office, has resulted in the instant halt of HIV treatment funding in Nigeria and other developing countries.
However, the U.S. Secretary of State Marco Rubio has now issued a waiver to allow the continuation of life-saving humanitarian assistance despite the pause. This means that, although foreign aid remains under suspension, certain critical forms of humanitarian aid are exempt from the freeze. Rubio had already granted an exemption for emergency food assistance a few days prior, and with this new waiver, additional essential aid is now permitted. Specifically, life-saving humanitarian assistance, as defined in the waiver, includes vital medical supplies, core life-saving medicines, urgent medical services, food, shelter, and basic subsistence support. The exemption also covers reasonable administrative costs necessary to deliver these forms of aid effectively.
Nonetheless, this waiver does not include vital health initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR). Launched in 2003 under President George W. Bush, PEPFAR has served as a fundamental aspect of global HIV/AIDS assistance, delivering life-saving antiretroviral therapy (ART) to millions worldwide. In Nigeria, PEPFAR aids nearly 1.3 million individuals in receiving HIV treatment, while also implementing prevention initiatives for high-risk groups. The abrupt halt on these funds—said to be linked to wider changes in U.S. foreign aid focuses—has put healthcare providers and patients in uncertainty.
The decision arrives at a precarious time. Nigeria’s healthcare system, already strained by COVID-19, now faces the dual challenge of maintaining HIV services amid dwindling resources. Experts warn that interrupted treatment could lead to drug resistance, increased transmission rates, and a spike in AIDS-related deaths. Women and children, who constitute over 60% of those receiving PEPFAR-supported care, are particularly vulnerable.
While the Trump administration has not provided detailed reasoning for the halt, analysts speculate it aligns with recent efforts to redirect foreign aid toward initiatives with clearer ties to U.S. strategic interests (“America First”). Critics argue this approach overlooks the interconnectedness of global health security.
Dr. Jirair Ratevosian, the chief of staff for PEPFAR during the Biden administration also added “HIV prevention and testing efforts can not be paused for 90 days — every delay allows new infections to spread unchecked. These programs are lifelines for millions, ensuring access to treatment, preventing transmission, and saving lives. Delaying them means lives hang in the balance and risks reversing decades of progress.”
Critics argue that this suspension could have devastating consequences. The U.S. is the largest single aid donor globally, and the freeze affects many dependent refugee camps and healthcare programs worldwide, including emergency responses to diseases like HIV, Marburg, mpox, bird flu, and polio. The Nigerian government has called for urgent dialogue to restore support, emphasizing the program’s role in stabilizing public health infrastructure. Local NGOs and global partners, such as the Global Fund, are working to address the deficit, but the magnitude of PEPFAR’s support—more than $400 million each year to Nigeria—creates a gap that no single organization can swiftly remedy.
As the 90-day evaluation period progresses, the worldwide community observes intently, worried about the possible lasting effects of this choice on global health programs and the millions who rely on them.
This choice also prompts queries regarding the future of American leadership in worldwide health. PEPFAR’s achievements in Nigeria, previously celebrated as a benchmark for successful foreign assistance, now confronts unpredictability. Health advocates emphasize that ongoing investment is essential not just to save lives but also to avert future pandemics. As Dr. Ayoade Alakija, a Nigerian epidemiologist, noted: “Health crises are interconnected. Neglecting HIV today could fuel the next global outbreak tomorrow.”
For now, clinics across Nigeria brace for the worst. As the world watches, the suspension of HIV funding to Nigeria serves as a stark reminder: in global health, progress is fragile, and solidarity is not just a moral imperative—it is a practical necessity.
